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Earlier this week, findings presented at the European Society of Endocrinology’s annual meeting in Barcelona, revealed that a series of scans may show variations in the brain activity and structure of patients with gender dysphoria.

The suggestions are that rather than mirroring that of their birth gender, the brain of the gender variant patient, may actually follow the pattern associated with the gender with which they identify.

This has led to the key question of whether this is to be the groundbreaking test that some have been waiting for.

In my time working as a gender specialist, many of my patients – both young and old –  have asked about the possibility of a ‘diagnostic tool’, something which ‘proves’ their gender variance. Some need it for their own peace of mind and others want to be able to demonstrate to their family, friends or work colleagues that what they are feeling is real.

A blood test, a scoring questionnaire, a brain scan, genetic testing, hormone evaluations. But no such tool exists to diagnose gender variance, in the same way that there is no way of diagnosing someone’s sexuality. Of course, in the case of sexuality, personal experience is all the diagnosis the individual – and society – need.

In the same way, some of my patients reject the idea that such a medical test is needed. They can tell you clearly whereabouts on the gender spectrum they identify, the challenge they face is getting their audience to listen – and take them seriously.

Perhaps a scan which offered irrefutable ‘proof’ that gender variance is a quantifiable biological phenomenon would resolve a whole raft of issues for anyone struggling with their gender who was looking to be able to corroborate their feelings. The ultimate ‘two finger salute’ to the haters: “I TOLD YOU I WAS TRANS!!!”

If only it were that simple.

Gender identity is a spectrum, a natural variation of human characteristic. At the last count there are over 37 ways in which people have identified. A scan may very well work for one person and not for someone else. That does not make the validity for those with any lesser results, any less real.

Imagine a transwoman who has lived her entire adult life with the innate knowledge that her gender differs from that perceived by the outside world. She has a scan but the results are inconclusive. Does this make her thoughts, feelings, experience and identity any less valid?

And what of those who exhibited greater levels of brain activity during the scan. Would this mean they were more in line with their lived gender than average? Would that person be more authentic in their transgender diagnosis? Could this lead to a trans hierarchy, a situation where we have degrees of people who are dismissed as a result of being less ‘trans’ than the scan’s gold standard?

I would argue that a patient’s self declared feelings of gender identity should be enough ‘proof’ for a medical professional to take their needs seriously.

The numbers are very small in this study. We need to be very careful about how the results are evaluated and interpreted, and how they may be allowed to influence the care of transgender patients.

The more tools we have to help us to provide the best possible treatment for this group of patients the better. The very real risk is that scans such as these become the litmus test for transgender validation – a tool that has the potential to divide the community and make them feel ever more exposed, vulnerable or alone.

We are breaking new ground. We must tread carefully and, crucially, we must act in the best interests of the patients, whatever the results of a scan may reveal.

 

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